Nosocomial urinary tract infection in intensive care unit patients

Catheter related nosocomial urinary tract infection is considered as one of the most important hospital acquired infections. This study was designed to determine the causative organisms causing catheter associated urinary tract infection in ICU patients as well to test the pattern of the antimicrobial sensitivity of the isolated organisms. Sixty patients admitted to ICUs in Ain Shams University Hospitals over the period from February to August 2007, were enrolled in this study. A significant urinary viable count >/= 10[3] CFU/ml was revealed from 37 cases, comprising 61.7%. On the other hand, fourteen patients [23.3%] provided insignificant count and nine [15%] showed no growth. Candida was the most common isolated organism 45.7% of all isolates followed by Enterococci 18.8%, Klebsiella pneumoniae spp 16.9%, thereafter E.coli, Pseudomonas aeruginosa and Enterobacter cloaca 4.2%, each. Proteus mirabilis, Providencia stuartii and Acinetrobacter baumannii were the least isolated organisms 2%. All Enterococci isolates were highly sensitive to norfloxacin followed by gentamicin, streptomycin, vancomysin and nitrofurantoin, respectively, and were highly resistant to ampicillin, and 22.2% of isolates were resistant to vancomycin. Klebsiella pneumoniae isolates were highly sensitive to cefotaxime-calvulonic acid, ceftazidime-clavulonic acid and imipenem followed by amikacin and were highly resistant to ampicillin, ciprofloxacin, norfloxacin, ticarcillin and piperacillin followed by amoxicillin-clavulonic acid, cephalothin, cefuroxime and azteronam and then cefotaxime, ceftazidime, gentamicin, nalidixic acid and nitrofurantoin. Isolates of E.coli were sensitive to ciprofloxacin, norfloxacin, nalidixic acid, nitrofurantoin, imipenem and amikacin but resistant to ampicllin, ticarcillin and tetracycline. Isolates of Pseudomonas aeruginosa were resistant to most antimicrobials except gentamicin and aztreonam. The incidence of extended spectrum beta-lactamse production by the Gram-negative bacilli was 41.1%. Seventy five percent of Klebsiella pneumoniae isolates were ESbetaL producers. The duration of catheterization was considered as an important risk factor for catheter related nosocomial urinary tract infection and there was higher prevalence of infection among cases with catheter duration more than 4 days

Nosocomial bacterial infections and antimicrobial resistance among the elderly in geriatric unit of Ain Shams university hospital

Increasing numbers of elderly people are being treated in hospitals and are additionally at particular risk of acquiring nosocomial infections [Nl] with antibiotic-resistant organisms. Prevalence of Nl had been evaluated in this study in all inpatients in Geriatric Medicine Unit, EL Demerdash Hospital of Ain Shams University from March 2004 till September 2006. The association of Nl with intrinsic and extrinsic risk factors was also assessed, as well as the emergence of antibiotic resistant bacterial strains. All specimens were processed by routine methods and their antibiotic sensitivity was performed using the disc diffusion method in accordance with the Clinical and Laboratory Standards Institute [CLSI] guide lines. A total of 107 NIs were found among 100 of the 1202 hospitalized patients [prevalence 8.2% prevalence varied greatly from 3.3% in the internal ward to 14.2% in the ICU]. Respiratory tract as well as urinary tract infections was the most common NIs [43% each]. The most commonly isolated pathogens from ICU and the internal ward were Klebsiella spp.[25%], Candida spp.[12%], Pseudomonas aeruginosa [12%] and methicillin-resistant Staphylococcus aureus [MRSA] [9%]. They were followed by Escherichia coli and Enterobacter spp. [7.5% each], coagulase negative Staphylococci [6%] and Proteus spp. [5%]. Depending on infection site, the most frequent isolates were Klebsiella spp. [41%], MRSA [22%] for respiratory tract infection; Candida spp. [28%], Klebsiella pneumonie [15%], E.coli and Pseudomonas auruginosa [13% each] for urinary tract infection. Our results showed that 61.9% of studied patients with lower respiratory infections were due to endotracheal intubation and 95.2% of patients had urinary catheters and developed urinary tract infections. About 82.0% of the elderly patients were taking antibiotics, for at least 1 month prior to admission, which have contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus spp., and multiple-drug-resistant Gram-negative bacilli and coagulase-negative staphylococcal strains. Colonization and infection with antibiotic resistant bacteria [ARB] is a rising menace in geriatric medicine. Establishing a surveillance system and developing an antibiotic policy provide the basis for antibiotic therapy and controlling antimicrobial resistance

Role of fungi in allergic bronchitis

Sputum samples from thirty asthmatic patients with recurrent infections were examined for fungi, as well as for acid fast bacilli and other pathogenic bacteria. 60 of cases were positive for fungi; either alone or associated with other bacteria. No one case showed acid fast bacilli. Eosinophilic count and serum immunoglobulin E [IgE] level were significantly high in all cases. Most of the patients, especially those infected with Candida species, showed clinical improvement after antimycotic treatment. It was concluded that hypersensitivity to fungal antigens was accused in many cases of allergic bronchitis. So the role of fungi in such cases must be taken in consideration and should be thoroughly investigated in order to choose the proper line of treatment

Role of cell mediated immune response in pathogenesis of cholesteatoma

The role of cell mediated immune [CMI] response in the initiation of aural cholesteatoma was studied. Migration inhibition test [MI1] was done for 20 patients with cholesteatoma, 10 with tubotympanic chronic otitis media and 10 normal subjects, using cholesteatoma matrix as an antigen. All cholesteatoma patients had significant positive leucocyte migration inhibition response compared to the other 2 groups [P<0.05], indicating a specific antigenicity and confirming the presence of CMI response in such patients. The level of leucocyte migration inhibition factor [LMIF] was significantly correlated with extension of the disease. In the mastoid disease, LMIF was higher than that in the localized attic one [P<0.05], indicating a relationship between the degree of immunological status and extent of cholesteatoma. Other parameters such as age, sex duration of the disease, recurrence or complications did not correlate with LMIF values. The bone resorption in cholesteatoma has been explained by the occurrence of CMI response, against cholesteatoma antigen, resulting in the release of many chemical mediators that might have a lytic activity. Further studies are recommended